Barriers to Primary Care After the Affordable Care Act: A Qualitative Study of Los Angeles Safety-Net Patients’ Experiences

Abstract

Purpose: Millions of people gained health care coverage in Los Angeles after the Affordable Care Act (ACA); however, challenges with obtaining and utilizing primary care still persist, particularly in the safety net. In this study, we explore barriers to accessing primary care services among safety-net patients in Los Angeles after Medicaid expansion and implementation of other programs for safety-net patients after the ACA. Methods: We conducted qualitative interviews, in Spanish and English, with 34 nonelderly adult patients in 1 of 3 insurance groups: Medicaid, MyHealthLA (a health care program for low-income undocumented individuals), or uninsured. We recruited participants from three sites in Los Angeles in 2017. We analyzed our interviews using a framework approach and included emerging concepts from participant responses. Results: We identified seven themes regarding barriers to accessing primary care: understanding the concept of primary care, finding a primary care provider (PCP), switching PCPs, getting timely appointments, geography and transportation, perceived cost or coverage barriers, and preferring emergency or urgent care over primary care. Patients with Medicaid were more likely to report barriers compared with other groups. Uninsured patients were less likely to understand the concept of primary care. Patients with MyHealthLA noted getting timely appointments and cost of care to be significant barriers. Conclusion: Despite Medicaid and other coverage expansions for safety-net patients after the ACA, substantial barriers to accessing primary care persist. Addressing such barriers through the development of targeted interventions or broader policy solutions could improve access to primary care for safety-net patients in Los Angeles.

Healthcare beliefs, health information seeking, and healthcare setting preferences among women who inject drugs by community supervision status

“…Primary care services may also be deprioritized by women on community supervision due to higher ranking daily needs, such as food and housing security (Dong et al, 2018), resulting in greater use of acute care services. In addition, a preference for emergency departments over other healthcare settings aligns with recent qualitative findings that Medicaid and public insurance enrollees described emergency departments and urgent care clinics as faster, cheaper, and more familiar than outpatient primary care settings (Saluja et al, 2019).…”

“…While legislation, such as the Affordable Care Act, has been enacted to increase insurance coverage among individuals recently released from incarceration or who are on community supervision (Bandara et al, 2015 ; Cuellar & Cheema, 2012 ; Knapp et al, 2019 ), improved insurance coverage has not sufficiently addressed gaps in outpatient service utilization rates among justice-involved individuals who have re-entered into the community and among the broader population of individuals on community supervision (Hawks et al, 2020 ; Saloner, Bandara, McGinty, & Barry, 2016 ). The continued underutilization of outpatient care among Medicaid enrollees has highlighted additional barriers to service use, such as perceived lack of coverage or unaffordable care, undervaluing primary care, length of time to first available appointment, and transportation (Saluja et al, 2019 ).…”

“…individuals who have re-entered into the community and among the broader population of individuals on community supervision (Hawks et al, 2020;Saloner, Bandara, McGinty, & Barry, 2016). The continued underutilization of outpatient care among Medicaid enrollees has highlighted additional barriers to service use, such as perceived lack of coverage or unaffordable care, undervaluing primary care, length of time to first available appointment, and transportation (Saluja et al, 2019).…”

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